Park Kyung Nam, Ryoo Seung-Hwa, Karm Myong-Hwan, Kim Hyun Jeong, Seo Kwang-Suk
Department of Dental Anesthesiology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea.
J Dent Anesth Pain Med. 2025 Feb;25(1):43-53. doi: 10.17245/jdapm.2025.25.1.43. Epub 2025 Jan 22.
Postoperative pain management is challenging in patients with oral cancer, especially those undergoing reconstructive surgery. Patient-controlled analgesia (PCA) is widely used, and fentanyl (FTN) concentration adjustments may improve pain control. This study aimed to evaluate the effects of FTN PCA concentration and reconstructive surgery on postoperative pain in patients with oral cancer.
This retrospective observational study analyzed 140 patients with oral cancer who underwent surgery under general anesthesia. Patients were categorized based on FTN PCA dosage (FTN 700 mcg and ketorolac 150 mg vs. FTN 1400 mcg and ketorolac 150 mg). Pain was assessed using the visual analog scale (VAS) at multiple time points postoperatively (0, 12, 24, 36, 48, 60, and 72 h). PCA usage patterns, including demand count, delivery count, and delivery/demand ratios, were compared across subgroups. Missing data were imputed using linear interpolation.
PCA usage and pain control were evaluated between the FTN 700 mcg (N = 40) and 1400 mcg (N = 100) groups, stratified by reconstruction status. Demographic characteristics showed no significant difference. In the reconstructive surgery subgroup, patients in the FTN 1400 mcg group showed lower PCA refill counts (1.45 ± 0.69 vs. 1.61 ± 0.58) and fewer delivery counts (17.1 ± 21.3 vs. 25.1 ± 28.5) compared to those in the FTN 700 mcg group, achieving similar or superior pain control with fewer interventions. Similarly, patients without reconstructive surgery in the FTN 1400 mcg group demonstrated lower PCA refill counts, shorter PCA usage times, and fewer delivery counts. VAS scores decreased consistently over time across all groups but remained higher in the reconstruction groups. Logistic regression analysis revealed that patients with reconstructive surgery in the FTN 1400 mcg group were more likely to achieve a VAS score of ≤ 3.0 at 72 h postoperatively (P = 0.022). These findings indicate FTN 1400 mcg's superiority in managing postoperative pain.
Comparing FTN PCA dosages, 1400 mcg demonstrated superior pain control to 700 mcg in patients undergoing oral cancer surgery, particularly those who underwent reconstructive surgery. This finding underscores the importance of optimizing FTN dosages to enhance postoperative pain management, reduce PCA-related demands, and achieve better patient outcomes.
口腔癌患者的术后疼痛管理具有挑战性，尤其是那些接受重建手术的患者。患者自控镇痛（PCA）被广泛使用，芬太尼（FTN）浓度调整可能会改善疼痛控制。本研究旨在评估FTN PCA浓度和重建手术对口腔癌患者术后疼痛的影响。
这项回顾性观察性研究分析了140例在全身麻醉下接受手术的口腔癌患者。患者根据FTN PCA剂量进行分类（FTN 700微克和酮咯酸150毫克与FTN 1400微克和酮咯酸150毫克）。在术后多个时间点（0、12、24、36、48、60和72小时）使用视觉模拟量表（VAS）评估疼痛。比较各亚组的PCA使用模式，包括需求次数、给药次数和给药/需求比。缺失数据采用线性插值法进行估算。
在FTN 700微克（N = 40）和1400微克（N = 100）组之间，根据重建状态分层评估PCA使用情况和疼痛控制。人口统计学特征无显著差异。在重建手术亚组中，与FTN 700微克组相比，FTN 1400微克组的患者PCA补充次数更低（1.45±0.69对1.61±0.58），给药次数更少（17.1±21.3对25.1±28.5），通过更少的干预实现了相似或更好的疼痛控制。同样，FTN 1400微克组中未进行重建手术的患者PCA补充次数更低，PCA使用时间更短，给药次数更少。所有组的VAS评分均随时间持续下降，但重建组的评分仍更高。逻辑回归分析显示，FTN 1400微克组中接受重建手术的患者在术后72小时更有可能达到VAS评分≤3.0（P = 0.022）。这些发现表明FTN 1400微克在管理术后疼痛方面具有优势。
比较FTN PCA剂量，1400微克在口腔癌手术患者中，尤其是那些接受重建手术的患者中，显示出比700微克更好的疼痛控制效果。这一发现强调了优化FTN剂量以加强术后疼痛管理、减少与PCA相关的需求并实现更好患者结局的重要性。
